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Customer obtai. .ed permit <br /> ' <br /> ORIGINAL STATZOFCALIFORNfA DO not fill in <br /> �. THE nzsoU ncrz; AGENCY �E <br /> File with DWR DEPARTMENT OF WATER RESOURCES _ No. 187166 <br /> t E Intent No _ WATER WELL DRILLERS REPORT State well No <br /> ClWermit No.or Data `I Other Well No.4 ;ji0 <br /> (1 OWNER: Noma Mn clan fx that f�rT.�S` � �r� <br /> ) (12) WELL LOG: Total doplh�l.tft.Depth.of completed well 7V fi. <br /> Address - 2 20 Wilco, from it, to ft. Formation (Describe by color, character, size or material) <br /> city__^ Stockton,_Calif. ��,,-25205 o2o Clay <br /> - <br /> (2) L0QAT10N OF WELL (see instructions), <br /> (:aunty n JJ0aquin Owner's Weil Number� 3O — L CladClay. <br /> Well address if different from above O <br /> Township qtnckton ga,s, eeeti 74 Clayfthnd <br /> Distance from cities,roads,railroads,fcuees,etc 74 90 Sc <br /> 0 - 0 SAA- <br /> 133 Cla <br /> (a) TYPE OF WORK: <br /> �! New Wet1]@ Deepening 0 !'— <br /> Reconstruction ❑ <br /> Reconditioning 0 — <br /> Horizontal Well 0 <br /> Destruction[I (Describe NZ"> — {� <br /> destruMEoa materlais ,J <br /> procedures In item - <br /> (4) PROPOSED <br /> Damesucpjz?-�V <br /> lydgaHan/ <br /> � . <br /> Industrial ` � ❑ � 1 y <br /> Ts"t `y ❑. <br /> —17 <br /> a <br /> WELL LOCATION SKETCH �' Other Q <br /> (5) EQUMbIENTs (6) GRA PACKS �� r <br /> Rosary Reverse ❑�N. S — <br /> Cable ❑ Air ❑ ,Z-filhtrieler of bo `j' f <br /> Other ❑ Bucket p from 5 0 a <br /> (7) CASING INSTALLED �4R,_ (S) PERFO fjT(Ss <br /> steel Q plastic§d Conc oa\lx Type of pe n a si-,a of scree ; — <br /> From T Dia. Gtige r F aZt To SIS ' <br /> ft. f1 In. Wall ft A`' slz = <br /> 0 9 0 ' ,) —16 0 '.s <br /> V <br /> (9) WELL SEALt "'' M1 <br /> Was surface sanitary seal provided? Yes%) No p If yes, to depth._S �l. <br /> Were strata seated a ainst Dello en? Yes 0 No ❑ Interval - — — ft. _ — <br /> Method of sea' M' tM'u to Work sta*t.c), 19 19000 <br /> (10) WATER LEVELS: WELL DAILLER'S STATEMENT: <br /> Ibepth of first water, if known_ w This well was drilled under my iurisdfetion an this report b true to the best of mV <br /> _ knou a and belre, <br /> Standing level after well completion it. � r� f <br /> (11) WELL TESTS: SIGNED f222. l <br /> Was well test made? Yes Q No ❑ If yes, by whom? ( R parr + <br /> Type of test Pump p Baller Q Air lift 0 NAM <br /> Depth to water at start of test _,k. At end of test' ft Person," or eorpara an ( cd or Anted) <br /> I/ after - halon Vater tempera <br /> Addres�T30C) S. F{ifro <br /> r lcity, Turlock, Calif. - Ftp <br /> 1 ysts made? Yes Cl Ne ❑ If yes, by whom? <br /> Oqlizk::� <br /> ctrielog made? Yes Q No [7 If yes.attach copy to this report License No. nate of this repo w — <br /> DWR 1e8 (fr[v.7-7e) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> j <br />